Elsevier

The Spine Journal

Volume 17, Issue 11, November 2017, Pages 1749-1754
The Spine Journal

Technical Report
Gender trends in authorship of spine-related academic literature—a 39-year perspective

https://doi.org/10.1016/j.spinee.2017.06.041Get rights and content

Abstract

Background Context

Despite recent advances in gender equity in medicine, the representation of women in orthopedic and neurosurgery remains particularly low. Furthermore, compared with their male colleagues, female faculty members are less likely to publish research, limiting opportunities in the academic promotion process. Understanding disparities in research productivity provides insight into the “gender gap” in the spine surgeon workforce.

Purpose

This study aims to determine the representation and longevity of female physician-investigators among the authors of five spine-related research journals from 1978 to 2016.

Study Design

This is a retrospective bibliometric review.

Methods

The authors of original research articles from five prominent spine-related journals (European Spine Journal, The Spine Journal, Spine, Journal of Spinal Disorders and Techniques, and Journal of Neurosurgery: Spine) were extracted from PubMed. For authors with a complete first name listed, gender was determined by matching first name using an online database containing 216,286 distinct names across 79 countries and 89 languages.

The proportion of female first and senior authors was determined during the time periods 1978 to 1994, 1995 to 1999, 2000 to 2004, 2005 to 2009, and 2010 to 2016. The authors who had their first paper published between 2000 and 2009 were included in additional analyses for publication count and longevity (whether additional articles were published 5 years after first publication). Student t test, chi-square analysis, and Cochran-Armitage trend test were used to determine significance between groups.

Results

From 1978 to 2016, 28,882 original research articles were published in the five spine-related journals. A total of 24,334 abstracts (90.9%) had first names listed, identifying 120,723 authors, in total of which 100,286 were successfully matched to a gender. A total of 33,480 unique authors were identified (female authors: 31.8%).

Female representation increased for first and senior authors from 6.5% and 4.7% (1978–1994) to 18.5% and 13.6% (2010–2016, p<.001). Growth in female senior author representation declined after 2000 (12.3% vs. 12.9% vs. 13.5% between 2000–2004, 2005–2009, and 2010–2016). Compared with male authors, on average, female authors published fewer articles (mean: 2.1 vs. 3.3, p<.001).

Of 15,304 authors who first published during 2000 to 2009, 3,478 authors (22.7%) continued to publish 5 years after their first publication. Female authors were less likely to continue publishing after their first article (15.3% of female authors vs. 24.8%, p<.001).

Conclusions

Female representation in academic spine research has doubled over the past 4 decades, although the growth of female representation as senior author has plateaued. Female physician-investigators are half as likely to continue participating in spine-related research longer than 5 years and on average publish half as many articles as senior author. In addition to recruiting more women into research, efforts should be made to identify and address barriers in research advancement and promotion for female physician-investigators.

Introduction

In 2015, women made up 52% of all matriculating medical students; however, women constitute only 14.8% and 17.3% of orthopedic and neurosurgery residents [1]. This disparity is even more pronounced in practicing physicians because, although 34% of practicing physicians are women, only 4.6% and 7.4% of practicing orthopedic surgeons and neurosurgeons are women [2], [3]. Furthermore, the percentage of women in spine surgery is lower than in any other orthopedic subspecialty [3].

This underrepresentation has been widely acknowledged and thought to be attributable to, among other factors, poor exposure to surgical subspecialties in medical student education, ongoing misperceptions about orthopedic surgery, and unconscious sex biases [4]. Female physician awardees of National Institute of Health career development awards report experiencing gender bias and sexual harassment [5]. In surveys of academic literature, there exists a “gender gap” in the representation of women as authors, especially in surgical literature with women rarely publishing as senior author (4%–6% of articles) [6], [7].

Over time, efforts have been made toward promoting gender diversity in regard to promotions and leadership opportunities; however, the progress of female representation within the field of spine-related research has not been previously described. Thus, the goals of this study were to determine how gender trends in authorship of spine-related academic literature have changed over the past 39 years. We hypothesize that although women are still less likely to take leadership roles as first or last author, the gender gap has decreased over time.

Section snippets

Data source

Citation data from 33,002 articles published between 1978 and 2016 in five peer-reviewed spine research journals (European Spine Journal [ESJ], The Spine Journal [SpineJ], Spine, Journal of Spinal Disorders and Techniques [now known as Clinical Spine Surgery; JSDT/CSS], and Journal of Neurosurgery: Spine [JNS]; Table 1) were extracted and retrieved from PubMed. Data elements included PubMed ID, journal name, article title, type of article, date of publication, and complete author listing. A

Prevalence of female authorship

Overall female representation increased over time from 7.3% (1978–1994) to 18.5% (2010–2016, p<.001; Fig. 1). Female representation increased for both first and senior authorships from 6.5% and 4.7% (1978–1994) to 18.5% and 13.6% (2010–2016, p<.001). Middle authorship experienced growth from 6.4 to 18.3% (p<.001). Growth in female senior author representation declined after 2000 (12.3% vs. 12.9% vs. 13.5% between 2000–2004, 2005–2009, and 2010–2016) relative to overall authorship participation

Discussion

In this study, we show that women continue to be underrepresented in academic spine literature. However, over the last 4 decades, there has been increasing involvement of female authors. Although there continues to be differences in the frequency with which women publish as first or senior author, as well as the sheer number of publications per unique author, these differences trend toward more gender parity. Although women continue to be underrepresented in the literature, these trends point

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Author disclosures: DCS: Nothing to disclose. DJ: Nothing to disclose. DO: Nothing to disclose.

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